Manager FWA and Subrogation

UHS•Reno, NV

About The Position

The Manager of Fraud, Waste, and Abuse (FWA) leads Prominence Health’s FWA, Subrogation, Third-Party Liability (TPL), and Payment Integrity programs. The role provides strategic direction and oversight for identifying, investigating, recovering, and resolving FWA, TPL, and payment integrity opportunities. Focus areas include End-Stage Renal Disease (ESRD) coordination of benefits, Medicare Secondary Payer (MSP) initiatives, overpayment recoveries, and other cost-containment and revenue-recovery activities. The Manager collaborates across departments and with external partners to ensure compliance with internal policies and applicable state and federal regulations, while maintaining a focus on accuracy, quality, financial stewardship, and timely service delivery. Prominence Health is a value-based care organization that works with affiliated health systems and independent providers to strengthen partnerships, advance market opportunities, and improve outcomes. Founded in 1993, it serves members, physicians, and health systems across Medicare, Medicare Advantage, Accountable Care Organizations, and commercial payer partnerships. Prominence Health is a subsidiary of Universal Health Services, Inc. (UHS).

Requirements

Bachelor’s degree or equivalent years of relevant work experience in a health-related field or insurance.
3–5 years of experience in healthcare, such as insurance, medical claims, medical front- or back-office, contracting, finance, or Provider Relations.
Experience in healthcare fraud investigations, auditing, data analytics, or a related field.
Ability to apply medical terminology knowledge when reviewing claims systems to determine approval or denial of coverage for claims related to accidents or illness.
Ability to manage a demanding investigative caseload.
Strong written skills and ability to compose detailed investigative reports and professional internal and external correspondence.
Strong interpersonal skills and a high level of professionalism, integrity, and ethics.
Excellent problem-solving and decision-making skills with attention to detail.
Proficient computer skills, including Microsoft Office (Word, Excel, PowerPoint, and Outlook) and Smartsheet.
Strict adherence to confidentiality and compliance rules and regulations.
Excellent time-management skills and a proven ability to meet deadlines.

Nice To Haves

Accredited Healthcare Fraud Investigator (AHFI) certification.
Certified Fraud Examiner (CFE) certification.
Certified Professional Coder (CPC) certification.
Experience with QNXT or another claims-processing application.
Previous experience in subrogation operations.

Responsibilities

Lead the FWA, Subrogation, Third-Party Liability (TPL), and Payment Integrity programs.
Provide strategic direction and oversight for the identification, investigation, recovery, and resolution of FWA, TPL, and payment integrity opportunities.
Oversee focus areas including ESRD coordination of benefits, Medicare Secondary Payer initiatives, overpayment recoveries, and other cost-containment and revenue-recovery activities.
Collaborate with internal departments and external partners.
Ensure compliance with internal policies and applicable state and federal regulations.
Maintain focus on accuracy, quality, financial stewardship, and timely service delivery.